EDN: Abdominal Injuries, Peritoneal Lab

Abdominal injuries

injuries hitting the visceral (hollow or solid) organs in the abdominal cavity.

acute peritonitis leading to shock

Damage to a hollow organ results in, what complication?

penetrating or blunt

Abdominal injuries may be classified as either

Penetrating abdominal injury

—usually the result of gunshot wounds or stab wounds.

Blunt abdominal injury

—usually caused by motor vehicle accidents or falls.

Blunt abdominal injury

is often associated with delayed complications, especially if there is injury to the liver, spleen, or blood vessels, which can lead to substantial blood loss into the peritoneal cavity

FAST UTZ (focused assessment on sonography for trauma)

diagnostic test for abdominal injuries?

FAST UTZ (focused assessment on sonography for trauma)

a rapid bedside ultrasound examination used to assess for blood abdominal organs after trauma, if there is DAMAGE to the liver, pancreas, spleen, or presence of peritonitis?

spleen

what is when damaged can be HIGHLY BLEED aside from the liver?

Donut bandaging

If there is an impaled object in the abdomen, leave it there. Stabilize the object in place with __________

beneath left diaphragm

kehr’s sign results to pain radiating to the left shoulder which is indicative of blood presence in the _______________

peritoneal irritation.

Firmly press, with the whole hand, the area of maximal tenderness (let the patient point to the area) Remove the fingers quickly to check for rebound tenderness; pain at suspected point indicate ______________??

Kehr’s sign

pain radiating to the left shoulder may be a sign of blood beneath the left diaphragm

laceration of the liver

pain in the right shoulder can result from ____________

lying flat

The patient must be in what position ___________ for this type of shoulder pain to occur.

Cullen sign

a slight bluish discoloration around the navel, is a sign of blood in the abdominal wall

Grey Turner’s sign

flank ecchymosis, is indicative of renal injuries or retroperitoneal bleeding or PANCREAS INJURY.

PAIN

is a poor indicator of the extent of an abdominal injury

Rebound tenderness and board-like rigidity

WHAT IS THE SIGNIFICANT indicative intra-abdominal injury

umbilical level

Look for increasing abdominal distention. Measure abdominal girth at WHAT LEVEL? early in your assessment which will serve as baseline from which changes can be determined.

a ruptured diaphragm

The presence of bowel sounds in the chest indicates

disrupted arterial blood flow.

Bruits over the aorta or other large arteries may indicate

silent abdomen

when you auscultate the abdomen, in patient with abdominal injury, what do you hear?

silent abdomen

is a red flag because it suggests that the intestines have stopped working properly, that indicates peritoneal irritation or ileus.

chest injuries

frequently accompany intra-abdominal injuries.

dullness

what is the sound NORMALLY you hear in liver and spleen?

tympani

In abdominal injuries, liver and spleen (solid organs) may sound __________ that indicates presence of air

dullness over regions normally containing gas

what abdominal sound characteristic may indicate presence of blood or other fluids.

Tympanic

what is the NORMAL SOUND OF ABDOMEN?

presence of blood

DULLNESS over the abdomen indicates what?

trauma to intestines

The presence of blood in DRE may be indicative of

Tachypnea, tachycardia, and hypotension

vital signs that may be clues to intra-abdominal bleeding.

bullet holes or stab marks

when cutting the clothing, DO NOT CUT THROUGH THE___________ These will be needed by law enforcement authorities as forensic evidence

MOIST WET DRESSINGS

what TYPE OF DRESSING USED FOR EVISCERATION?

DONUT BANDAGE

what type of BANDAGE USED FOR PENETRATING INJURIES?

NG tube

This will serve to empty the stomach, relieve gastric distention, and facilitate abdominal assessment

stomach injury or esophageal injury.

In addition, if blood is found in NGT, it may indicate

Withhold oral fluids

intervention to prevent increased peristalsis and vomiting

indwelling urethral catheter

Insert an ___________ to ascertain the presence of hematuria and to monitor urine output.

catheter should not be placed

If a fracture of the pelvis is suspected,_____________ until the integrity of the urethra is ensured.

analgesics

tetanus prophylaxis

broad-spectrum antibiotics.

Pharmacologic interventions for abdominal injuries?

Focused assessment with sonography in trauma (FAST)

is a standard for rapid bedside assessment with ultrasound performed by providers to identify free fluid in the abdomen, pericardium, or peritoneum.

oliguria

it is a sign that px is having a shock

kidney injury

hematuria indicates

Peritoneal Lavage

it is a technique of irrigation of peritoneal cavity and examination of the irrigating fluid to evaluate the effects of trauma to the abdomen

supine position

POSITION OF THE PATIENT FOR PERITONEAL LAVAGE?

immediate or STAT exploratory laparotomy

If more than 10 ml of blood is obtained or the fluid contains bile, feces, or particular matter, the test is considered POSITIVE and the patient is prepared for

500-1000 ml PLR

If no blood is present, catheter is attached to the IV tubing then how much solution is INFUSED?

PLACED lower than abdominal level

After solution is infused and FINISHED, the empty IV bag is removed and ____________ to promote drainage

sent to laboratory

Fluid recovered from drainage what will be done?

lack of significant intraperitoneal bleeding

FLUID DRAINED : test is negative if clear fluid indicates

free blood, bile, feces, or food particles, presence of RBC, WBC, and amylase under microscopic exam

FLUID DRAINED : test is positive if there is aspiration of

Epinephrine

what medication is given for peritoneal lavage?

2 cm below the umbilicus

where exact location is peritoneal lavage catheter is inserted?

peritoneal cavity.

Assist when the peritoneal catheter is inserted into the __________ then aspirated, then NOTE THE fluid aspirated if with or without blood present.

intestine protrusion to diaphragm and ruptured.

If there is FECES in the thoracic cavity DURING CTT, what does it indicates?

local anesthesia

what type of anesthesia is used in peritoneal lavage?

double gloving, deep breaths and bear down, priority VS - HEART RATE

nursing consideration for DRE?